HIV/AIDS & Viral Hepatitis In the Criminal Justice Profession

HIV/AIDS & Viral Hepatitis In the Criminal Justice Profession
TCOLE Course # 3804 Texas Commission On Law Enforcement and Texas Department of State Health Services AND MASTER BCCO PCT #4 PowerPoint BCCO PCT #4 PowerPoint

ADMINISTRATIVE Please complete the BCCO PCT #4 Registration form and turn it in now. Make sure you sign TCOLE Report of Training (PID#, Full Name and DOB). All cell phones off please – pay attention to course materials and show common respect & courtesy.

COURSE/LESSON OVERVIEW
The purpose of this course is to educate individuals on matters pertaining to communicable diseases such as HIV/AIDS, HBV, and HCV which impacts the criminal justice profession.

Learning Objectives Learning Objective 2.0: The participant will be able to understand and explain relevant terms and definitions of HIV/AIDS, HBV and HCV Learning Objective 2.1 :The participant will be able to write general statements regarding HIV. Learning Objective 2.2 :The participant will be able to to list and describe the general stages of HIV infection.

Learning Objectives Learning Objective 2.3 :The participant will be able to write general statements regarding AIDS. Learning Objective 2.2 :The participant will be able to describe in writing, the relationship between HIV and AIDS. Learning Objective 2.5 :The participant will be able to write general statements regarding Hepatitis A (HAV). Learning Objective 2.6 :The participant will be able to write general statements regarding Hepatitis B (HBV).

Learning Objective 2.7The participant will be able to describe the relationship between acute and chronic HBV infection. Learning Objective 2.8. participant will be able to write general tatements regarding HCV. Learning Objective 9.2 :The participant will be able to describe the relationship between acute and chronic HCV infection.

FORWARD The occurrence of communicable diseases has dramatically affected every part of the justice system worldwide; Legal, law enforcement and custody issues. HIV, AIDS, hepatitis, and other sexual transmitted diseases (STDs) are big problems in the judicial system.

Acknowledgement This course is developed by the Texas Commission on Law Enforcement (TCOLE) for presentation to any individual associated with or employed by any entity of the criminal justice system.

Unit One 1.0 Functional Area: This section will introduce the participant to HIV/AIDS, HBV, and HCV. The participant will master an understanding of the relevant terms and definitions of HIV/AIDS, HBV and HCV.

Learning Objective 1.1 Learning Objective: The participant will be able to write general statements regarding HIV.

1.1 General Statement (HIV)
A. What is HIV? H = Human I = Immunodeficiency V = Virus 1.1 Learning Objective: The student will be able to identify general statements regarding HIV. Human: only humans get HIV and pass it to other humans through specific fluids and during specific activities; the virus does not live outside the human body Immunodeficiency: the immune system is what fight off illnesses; HIV destroys the body's ability to fight infections and certain cancers by killing or damaging cells of the body's immune system. Virus: – A microorganism that causes infectious diseases; in general, viruses either run their course (like a viral cold/flu infection) or a person lives with it and it can and frequently does have symptomatic and non-symptomatic stages (like herpes, human papillomavirus, and/or HIV). We consider these infections to be treatable, but not curable. Treatments are available to interrupt reproduction of virus and/or to help relieve symptoms. HIV affects people of every race, color, sex, sexual orientation, social class and marital status. It is a non-discriminating virus.

1.1 General Statement (HIV) Cont’d
Virus that causes AIDS Once a person is infected, they can immediately transmit HIV to another person

Destroys the body's ability to fight infections and certain cancers by killing or damaging cells of the body's immune system A person infected may remain without symptoms for a long period of time

There is no cure for HIV. Once an individual becomes infected with HIV the person is infected for life. Drugs to fight both HIV infection and its associated infections and cancers are currently available.

Increased understanding of HIV disease progression, refinement and acceptance of holistic therapies, availability of sophisticated testing, ability to prevent or reduce the impact of opportunistic infections, and potent treatment therapies have made HIV an increasingly manageable chronic disease.

Learning Objective 1.2 Learning Objective: The participant will be able to list and describe the general stages of HIV infection.

1.2 General Stages of HIV Infection.
A. There are general stages of HIV infection that one may go through before AIDS develops. 1.2 Learning Objective: The student will be able to identify general stages of HIV infection. There are general stages of HIV infection that one may go through before AIDS develops. Infection. HIV enters the bloodstream and begins to take up residence in the cells. People with HIV are considered to be infectious immediately after infection with the virus. Although some studies suggest that the level of infectivity varies over time depending on the stage of the disease in which the person is, it is not possible for most HIV-infected people to find out what their level of infectivity is. A person with HIV is infectious at all times. Also, a person does not need to have symptoms or look sick to have HIV. In fact, people may look perfectly healthy for many years despite the fact that they have HIV in their bodies. The only way to find out if a person is infected is by taking an HIV antibody test. Primary HIV infection is the first stage of HIV disease, when the virus first establishes itself in the body. Some researchers use the term acute HIV infection to describe the period of time between when a person is first infected with HIV and when antibodies against the virus are produced by the body (usually 6-12 weeks). Within the first 72 hours after exposure, post-exposure prevention (PEP) may be possible. Up to 70% of people newly infected with HIV will experience some "flu-like" symptoms. These symptoms, which usually last no more than a few days, might include fevers, chills, night sweats and rashes (not cold-like symptoms). The remaining percentage of people either do not experience "acute infection," or have symptoms so mild that they may not notice them. Given the general character of the symptoms of acute infection, they can easily have causes other than HIV, such as a flu infection. For example, if you had some risk for HIV a few days ago and are now experiencing flu-like symptoms, it might be possible that HIV is responsible for the symptoms, but it is also possible that you have some other viral infection. During acute HIV infection, the virus makes its way to the lymph nodes, a process which is believed to take three to five days. Then HIV actively reproduces and releases new virus particles into the bloodstream. This burst of rapid HIV replication usually lasts about two months. People at this stage often have a very high HIV "viral load." However, people with acute HIV infection usually will not test HIV antibody positive, since it takes the body approximately one to three months to produce antibodies against HIV. Scientists disagree about whether anti-HIV treatment is useful during primary HIV infection, and there is little information from clinical trials. Most HIV specialists believe that early highly active antiretroviral therapy (HAART) is useful, and that its benefits likely outweigh the disadvantages of no treatment. Some doctors are treating newly HIV-infected people with a combination of anti-HIV drugs. While many researchers are optimistic about early anti-HIV treatment, they are also concerned about drug side effects, long-term effects and the possibility of developing drug-resistant virus if people use powerful anti-HIV drugs before they become ill due to HIV disease. Some researchers think that if HIV replication can be slowed down early in the course of disease, it will take longer before a person develops AIDS. Several studies have shown that low blood viral load levels in the early stages of HIV disease are associated with less severe illness and slower disease progression. Some even think that it might be possible to eradicate, or completely kill off HIV, if treatment is started very early. So far, though, complete HIV eradication has not occurred, and most doctors recommend that anti-HIV treatment should be continued indefinitely once it is started.

1.2 General Stages of HIV Infection…Cont’d
B. Infection. The earliest stage is right after infection with HIV. HIV can infect cells and copy itself before the immune system has started to respond. Individuals may feel flu-like symptoms during this time.

HIV enters the bloodstream and begins to take up residence in the cells. People with HIV are considered to be infectious immediately after infection with the virus. Seroconversion This term refers to the time when the body begins producing antibodies to the virus. About 95% of the people infected with HIV will develop antibodies within three months after infection. Nearly all people will develop antibodies within six months after infection. Most people develop antibodies within three months and some can take up to six months. People who get tested need to wait at least three months for the test. If their first result is negative, they should come back for a second test three months later. Immune System Decline The virus appears to slowly damage the immune system for a number of years after infection (perhaps because the body is able to keep it in check during this time). In most people, however, a faster decline of the immune system occurs at some point, and the virus rapidly replicates. This damage can be seen in blood tests, such as lowered T-cell counts, before any actual symptoms are experienced. People who are HIV-positive should see a doctor to monitor their immune systems. By getting lab indicators (such as the viral load test) and observing how they are changing over time, they can get a better sense of whether HIV has already caused any damage to their immune systems. As mentioned above, a development in the last couple of years in the treatment of HIV disease is what doctors call "Early Intervention" or "Early Care." The principle behind this concept is that early rather than late medical care may give people better chances of survival and better quality of life. It is extremely important that people with HIV learn that they have to see a doctor even if they feel fine at the moment because the virus could be already damaging their immune systems. Understanding that HIV Disease begins immediately after infection enables us to begin treating infected persons before symptoms appear. This important medical advance has significantly extended the lifespan -- and the hope -- of HIV-infected people. Mild, Non-Specific Symptoms Once the immune system is damaged, many people will begin to experience some mild symptoms (skin rashes, fatigue, slight weight loss, night sweats, thrush in the mouth, etc.). Most, though not all, will experience mild symptoms such as these before developing more serious illnesses. Although one's prognosis varies greatly depending on one's ability to access support, services and preventative treatment, it is generally believed that it takes the average person five to seven years to experience their first mild symptom. These symptoms are not specific to AIDS. However, they should be of concern to people who have tested positive to HIV. Usually, symptoms occur when the virus has already caused considerable damage to the immune system. For that reason, people with HIV should not wait until symptoms appear to get medical treatment. Also, people with high risk for HIV should not wait to get symptoms to take the HIV-antibody test. If you are a person with HIV experiencing any symptoms, we suggest that you have them checked by a health care worker. 1.2 General Stages of HIV Infection…Cont’d

Infection – Cont’d Although some studies suggest that the level of infectivity varies over time depending on the stage of the disease in which the person is, it is not possible for most HIV-infected people to find out what their level of infectivity is. A person with HIV is infectious at all times. More Severe Symptoms; Opportunistic Infections and Diseases When immune system damage is more severe, people may experience opportunistic infections (called "opportunistic" because they are caused by organisms which cannot induce disease in people with normal immune systems, but take the "opportunity" to flourish in people with HIV). Most of these more severe infections, diseases and symptoms fall under the Centers for Disease Control's definition of full-blown "AIDS." Receiving an AIDS diagnosis does not necessarily mean that the person will die soon. Some people have lived many years after their diagnosis. However, it is extremely important that people in this stage of HIV disease get adequate care for any symptoms or conditions that develop. People with an AIDS diagnosis have coined the term "living with AIDS" to describe their experience. We prefer this term over others because it implies empowerment which may be crucial in maintaining a positive frame of mind and possibly even in surviving longer. As the term "HIV-disease" becomes more common, many people are also using the term "living with HIV" to refer to anyone who has the virus. Does everyone who has HIV eventually get sick? Nobody knows. Many researchers believe that, in some small percentage of people with HIV, the immune system may be able to defeat the virus. As existing treatments are used earlier in the course of HIV disease and new treatments are developed, these, too, will postpone, and possibly prevent, illness. Unfortunately, however, studies show that the majority of untreated people do eventually become ill from HIV. Some long-term survivors may do so well because of their unique body chemistry, or access to a combination of medical, emotional and spiritual support, or something yet unknown to us. Others may find their health declining even with access to all of these things. We don't really know the answer yet, although you can be sure scientists and researchers are searching for the common thread that links long-term survivors together. 1.2 General Stages of HIV Infection…Cont’d

Also, a person does not need to have symptoms or look sick to have HIV. In fact, people may look perfectly healthy for many years despite the fact that they have HIV in their bodies. The only way to find out if a person is infected is by taking an HIV antibody test. 1.2 General Stages of HIV Infection…Cont’d

C. Response. The next stage is the body responds to the virus. Even if a person doesn’t feel any different, their body is trying to fight the virus by making antibodies against it. This is called sero-conversion, when a person goes from being HIV negative to HIV positive. 1.2 General Stages of HIV Infection…Cont’d

D. No symptoms. HIV infected individuals may enter a stage in which they have no symptoms. This is called asymptomatic infection. They still have HIV and it may be causing damage that they can’t feel.

E. Symptoms. Symptomatic HIV infection is when symptoms are developed, such as certain infections, including PCP. F. AIDS. AIDS is diagnosed when you have a variety of symptoms, infections, and specific test results. There is no single test to diagnose AIDS.

Primary HIV infection FACTS
1.2 General Stages of HIV Infection…Cont’d Primary HIV infection FACTS Primary HIV infection is the first stage of HIV disease, when the virus first establishes itself in the body. Some researchers use the term acute HIV infection to describe the period of time between when a person is first infected with HIV and when antibodies against the virus are produced by body (usually 6-12 weeks).

Within the first 72 hours after exposure, post-exposure prevention (PEP) may be possible.
Up to 70% of people newly infected with HIV will experience some "flu-like" symptoms. These symptoms, which usually last no more than a few days, might include fevers, chills, night sweats and rashes (not cold-like symptoms). 1.2 General Stages of HIV Infection…Cont’d

The remaining percentage of people either do not experience "acute infection," or have symptoms so mild that they may not notice them. Given the general character of the symptoms of acute infection, they can easily have causes other than HIV, such as a flu infection. 1.2 General Stages of HIV Infection…Cont’d

For example, if you had some risk for HIV a few days ago and are now experiencing flu-like symptoms, it might be possible that HIV is responsible for the symptoms, but it is also possible that you have some other viral infection. 1.2 General Stages of HIV Infection…Cont’d

This burst of rapid HIV replication usually lasts about two months.
During acute HIV infection, the virus makes its way to the lymph nodes, a process which is believed to take three to five days. Then HIV actively reproduces and releases new virus particles into the bloodstream. This burst of rapid HIV replication usually lasts about two months. 1.2 General Stages of HIV Infection…Cont’d

People at this stage often have a very high HIV "viral load."
However, people with acute HIV infection usually will not test HIV antibody positive, since it takes the body approximately one to three months to produce antibodies against HIV 1.2 General Stages of HIV Infection…Cont’d

Scientists disagree about whether anti-HIV treatment is useful during primary HIV infection, and there is little information from clinical trials. Most HIV specialists believe that early highly active antiretroviral therapy (HAART) is useful, and that its benefits likely outweigh the disadvantages of no treatment. 1.2 General Stages of HIV Infection…Cont’d

Some doctors are treating newly HIV-infected people with a combination of anti-HIV drugs.
While many researchers are optimistic about early anti-HIV treatment, they are also concerned about drug side effects, long-term effects and the possibility of developing drug-resistant virus if people use powerful anti-HIV drugs before they become ill due to HIV disease. Some researchers think that if HIV replication can be slowed down early in the course of disease, it will take longer before a person develops AIDS. Several studies have shown that low blood viral load levels in the early stages of HIV disease are associated with less severe illness and slower disease progression. Some even think that it might be possible to eradicate, or completely kill off HIV, if treatment is started very early. So far, though, complete HIV eradication has not occurred, and most doctors recommend that anti-HIV treatment should be continued indefinitely once it is started.

Stages of HIV Infection
Primary HIV Infection Sero-conversion (Response) Immune System Decline Mild, non-specific Symptoms More Severe Symptoms; Opportunistic Infections and Diseases/AIDS 1.2 Learning Objective: The student will be able to identify general stages of HIV infection. There are general stages of HIV infection that one may go through before AIDS develops. Infection. HIV enters the bloodstream and begins to take up residence in the cells. People with HIV are considered to be infectious immediately after infection with the virus. Although some studies suggest that the level of infectivity varies over time depending on the stage of the disease in which the person is, it is not possible for most HIV-infected people to find out what their level of infectivity is. A person with HIV is infectious at all times. Also, a person does not need to have symptoms or look sick to have HIV. In fact, people may look perfectly healthy for many years despite the fact that they have HIV in their bodies. The only way to find out if a person is infected is by taking an HIV antibody test. Primary HIV infection is the first stage of HIV disease, when the virus first establishes itself in the body. Some researchers use the term acute HIV infection to describe the period of time between when a person is first infected with HIV and when antibodies against the virus are produced by the body (usually 6-12 weeks). Within the first 72 hours after exposure, post-exposure prevention (PEP) may be possible. Up to 70% of people newly infected with HIV will experience some "flu-like" symptoms. These symptoms, which usually last no more than a few days, might include fevers, chills, night sweats and rashes (not cold-like symptoms). The remaining percentage of people either do not experience "acute infection," or have symptoms so mild that they may not notice them. Given the general character of the symptoms of acute infection, they can easily have causes other than HIV, such as a flu infection. For example, if you had some risk for HIV a few days ago and are now experiencing flu-like symptoms, it might be possible that HIV is responsible for the symptoms, but it is also possible that you have some other viral infection. During acute HIV infection, the virus makes its way to the lymph nodes, a process which is believed to take three to five days. Then HIV actively reproduces and releases new virus particles into the bloodstream. This burst of rapid HIV replication usually lasts about two months. People at this stage often have a very high HIV "viral load." However, people with acute HIV infection usually will not test HIV antibody positive, since it takes the body approximately one to three months to produce antibodies against HIV. Scientists disagree about whether anti-HIV treatment is useful during primary HIV infection, and there is little information from clinical trials. Most HIV specialists believe that early highly active antiretroviral therapy (HAART) is useful, and that its benefits likely outweigh the disadvantages of no treatment. Some doctors are treating newly HIV-infected people with a combination of anti-HIV drugs. While many researchers are optimistic about early anti-HIV treatment, they are also concerned about drug side effects, long-term effects and the possibility of developing drug-resistant virus if people use powerful anti-HIV drugs before they become ill due to HIV disease. Some researchers think that if HIV replication can be slowed down early in the course of disease, it will take longer before a person develops AIDS. Several studies have shown that low blood viral load levels in the early stages of HIV disease are associated with less severe illness and slower disease progression. Some even think that it might be possible to eradicate, or completely kill off HIV, if treatment is started very early. So far, though, complete HIV eradication has not occurred, and most doctors recommend that anti-HIV treatment should be continued indefinitely once it is started.

Learning Objective 1.3 Learning Objective: The student will be able to write general statements regarding AIDS.

D = deficiency S = Syndrome 1.3 What is AIDS? A = Acquired I = Immuno-
1.3 Learning Objective: The student will be able to identify general statements regarding AIDS. Acquired you have to get HIV from someone else Immunodeficiency: the immune system is what fight off illnesses; HIV destroys the body's ability to fight infections and certain cancers by killing or damaging cells of the body's immune system. Syndrome: A set of signs or a series of events occurring together that often point to a single disease or condition as the cause; people living with AIDS tend to get sick from similar illnesses

1.3 General Statements (AIDS)
A. AIDS is the common abbreviation for Acquired Immunodeficiency Syndrome B. The term AIDS applies to the most advanced stages of HIV infection AIDS is the common abbreviation for Acquired Immunodeficiency Syndrome. The term AIDS applies to the most advanced stages of HIV infection. AIDS is the result of the natural progression of HIV infection. The acquired immunodeficiency syndrome (AIDS) was first recognized in 1981

1.3 General Statements (AIDS) – Cont’d
C. AIDS is the result of the natural progression of HIV infection D. The acquired immunodeficiency syndrome (AIDS) was first recognized in 1981

Learning Objective 1.4 Learning Objective: The participant will be able to describe in writing, the relationship between HIV and AIDS

Relationship between HIV & AIDS
Individuals don’t transmit AIDS, they transmit HIV HIV progresses in each individual differently Immune system breakdown causes opportunistic infections/AIDS Common opportunistic infections (PCP, KS, MAC, TB) 1.4 Learning Objective: The student will be able to understand the relationship between HIV and AIDS. Individuals don’t transmit AIDS they transmit HIV. As a result of HIV, infections that are allowed because of the impaired immune system are called “opportunistic infections.” These infections generally do not affect healthy people. The definition or diagnosis of AIDS includes all HIV-infected persons who have fewer than 200 CD4+ T cells per cubic millimeter of blood. (Healthy adults usually have CD4+ T-cell counts of 1,000 or more.) In addition, the definition includes 26 clinical conditions that affect people with advanced HIV disease. Common opportunistic infections associated with HIV are: Pneumocystis carinii pneumonia (PCP) Kaposis Sarcoma (KS) Mycobacterium avium complex (MAC) Tuberculosis (TB). This has become much more common in prisons/jails. A new form of TB (Multi-drug resistant) is now being seen in much higher numbers. It is particularly dangerous because it cannot be treated with the more common drugs used to treat TB. Persons living with HIV/AIDS are at a very high risk for MDR-TB. HIV infection progresses in each individual differently; individual immune systems, health behaviors, resources, and chance all contribute to the course of infection.

How would I know if I have HIV?
The only sure way to know your status is to be tested The most common test is an antibody test\ The antibody test (EIA) detects infection in most persons within 6 weeks to 3 months Any positive antibody test must be confirmed with a second type of test, the Western Blot Both tests (EIA and Western Blot) must be positive for someone to be told s/he has HIV There are a variety of ways to test for HIV. Some require a tube of blood, others a drop or two of your blood, some use cells from the lining of your cheek/saliva, still others are available that can detect antibodies in urine. There are now tests that can indicate infection with HIV within minutes although those preliminary results from Rapid testing need to be confirmed with another type of test before telling someone s/he is positive for HIV.

Split Decision Split Decision intends to open the lines of communication in relationships as it relates to the rapidly spreading HIV virus. This is a five minute short film of a longer piece of work directed by Sanedria Arne’ Porter, writer/director originally from Winston-Salem, N.C. currently residing in Atlanta, Georgia. This short film was written by Sanedria Arne' Potter & Kirk A. Moore.

Learning Objective 1.5 Learning Objective: The student will be able to write general statements regarding Hepatitis A (HAV).

What is Hepatitis? Hepatitis is:
A disease that causes inflammation of the liver What does the liver do? The liver is an organ that helps your body digest food and acts as a filter for poisons or anything toxic in the body Where is it located? It is located in the upper right quadrant of the abdomen, tucked up under your rib cage.

General Statements (Hepatitis A – HAV)
Hepatitis A (HAV) is a liver disease caused by the Hepatitis A virus 1/3 of Americans have evidence of past HAV infection Hepatitis A is found in the stool (feces) or persons infected with HAV

General Statements (Hepatitis A – HAV)
It is usually spread when a person eats food or drinks water that has been contaminated with the feces of someone with HAV It is important to wear gloves when handling inmate linen or clothing

Signs and Symptoms of HAV
Persons may not have any symptoms Older persons are more likely to have symptoms than children If symptoms are present, they usually occur quickly and may include: Fever Tiredness Loss of appetite - Nausea Abdominal Discomfort - Jaundice Dark urine

Signs and Symptoms of HAV
The average incubation time from exposure to symptoms is 28 days (15-50 days) Symptoms usually last less than 2 months

Long-term Effects of HAV
There is no chronic (long-term) infection One you have had hepatitis A, you cannot get it again There is a vaccine for hepatitis A If you have been exposed, Immune globulin can be given to prevent infection (within 14 days of exposure) About 15% of people infected with HAV will have prolonged or relapsing symptoms over a 6-9 month period The vaccine appears to last for at least 20 years The vaccine consists of two shots (initial shot and then one 6 months later) Immunogenicity in children, adolescents, adults following the vaccine: 94-100% positive 1 month after dose 1 99-100% positive after dose 2

Learning Objective 1.6 Learning Objective: The student will be able to write general statements regarding Hepatitis B (HBV).

What is Hepatitis B? Hepatitis B is an inflammation of the liver caused by infection with the hepatitis B virus (HBV) Hepatitis B is spread through contact with infected blood (usually through sex or sharing needles/works) HBV has both acute (new, short-term) and chronic stages (ongoing, long-term) The severity of the disease can range from mild or unapparent to severe or even fatal 1.6 Learning Objective: The student will be able to identify general statements regarding HBV. HBV is the common abbreviation for hepatitis B virus. Hepatitis B is an inflammation of the liver caused by infection with the hepatitis B virus Hepatitis B is spread through contact with infected blood (usually transmitted during sex and/or sharing needles or other works used to prepare and inject drugs). The Asian community has much higher rates of HBV than any other racial/ethnic group in the US. This is an infection that has frequently been spread from one generation to the next during delivery. HBV has both acute (new, short-term) and chronic stages (ongoing, long-term). The severity of the disease can range from mild or unapparent to severe or even fatal. It is estimated that 5,000 people die each year in the United States due to the complications of cirrhosis and liver cancer as a result of HBV. Hepatitis B vaccination is recommended for all unvaccinated adolescents, all unvaccinated adults at risk for HBV infection, and all adults seeking protection from HBV infection.

Transmission of HBV You can get infected with HBV by:
Contacting blood/body fluids containing blood if you are not immune (via vaccine/ prior infection) 2. Having sex with an infected person without using a condom 3. Sharing needles to inject drugs or “works” (spoons, cotton, water)

Signs and Symptoms of HBV
If you have HBV, you may experience: Jaundice (eyes and/or skin) Loss of appetite Nausea, vomiting, fever, stomach or joint pain Fatigue lasting weeks or months The average incubation period (from exposure to symptoms) is approximately 4 months

Learning Objective 1.7 Learning Objective: The student will be able to describe the relationship between acute and chronic HBV infection.

Relationship between Acute & Chronic HBV
Acute hepatitis B occurs shortly after exposure to the virus Chronic hepatitis B is an infection that lasts longer than 6 months About 85% of people who are infected are able to fight off the virus so their infection never becomes chronic The younger you are when you become infected with the hepatitis B virus, the more likely you are to develop chronic hepatitis B 1.7 Learning Objective: The student will be able to understand the relationship between acute and chronic HBV infection. Acute hepatitis B occurs shortly after exposure to the virus. Chronic hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely. About 85% of people who are infected are able to fight off the virus so their infection never becomes chronic. The younger you are when you become infected with the hepatitis B virus, the more likely you are to develop chronic hepatitis B. The CDC estimates that 1.25 million Americans are chronically infected, with 20-30% of them acquiring their infection during childhood

HBV Vaccine The Hepatitis B vaccine is the best protection against HBV
Immune globulin can be given within 7 days if you are exposed to HBV and not vaccinated. You should also be given the first dose of HBV vaccine Three doses are needed for complete protection (0, 1-2, 4-6 months) Hepatitis B vaccination is recommended for all unvaccinated adolescents, all unvaccinated adults at risk for HBV infection, and all adults seeking protection from HBV infection. Most states now require children to have received the HBV vaccine before entry into school and most babies receive their first immunization with the HBV vaccine before they leave the hospital (1-2 days of age). The vaccine was licensed in 1982; currently recombinant (in US) It is a 3 dose series, typical schedule 0, 1-2, 4-6 months - no maximum time between doses (no need to repeat missed doses or restart) There is also a 2 dose series (adult dose) licensed by FDA for year olds (Merck) Protection ~30-50% dose 1; 75% - 2; 96% - 3; lower in older, immunosuppressive illnesses (e.g., HIV, chronic liver diseases, diabetes), obese, smokers

HBV Vaccine Most young adults and children have been vaccinated against HBV by the age of 2 (or years of age if not vaccinated as a child) The CDC, the National Commission on Correctional Health Care and the Society of Correctional Physicians recommend that correctional officers and correctional health care workers be vaccinated against HBV Hepatitis B vaccination is recommended for all unvaccinated adolescents, all unvaccinated adults at risk for HBV infection, and all adults seeking protection from HBV infection. Most states now require children to have received the HBV vaccine before entry into school and most babies receive their first immunization with the HBV vaccine before they leave the hospital (1-2 days of age). The vaccine was licensed in 1982; currently recombinant (in US) It is a 3 dose series, typical schedule 0, 1-2, 4-6 months - no maximum time between doses (no need to repeat missed doses or restart) There is also a 2 dose series (adult dose) licensed by FDA for year olds (Merck) Protection ~30-50% dose 1; 75% - 2; 96% - 3; lower in older, immunosuppressive illnesses (e.g., HIV, chronic liver diseases, diabetes), obese, smokers

Learning Objective 1.8 Learning Objective: The student will be able to write general statements regarding Hepatitis C (HCV).

What is Hepatitis C? Hepatitis C (HCV) is an inflammation of the liver caused by infection with the hepatitis C virus HCV is the most common chronic blood borne viral infection in the United States HCV is the #1 cause of chronic liver disease and liver transplants HCV has both acute and chronic stages There is not a vaccine to prevent hepatitis C 1.7 Learning Objective: The student will be able to identify general statements regarding HCV. HCV is the common abbreviation for hepatitis C virus. Hepatitis C is an inflammation of the liver caused by infection with the hepatitis C virus. HCV is the most common chronic blood borne viral infection in the United States. HCV is the #1 cause of chronic liver disease and liver transplants. HCV has both acute and chronic stages. There is no vaccine to prevent hepatitis C.

Transmission of HCV HCV is transmitted through blood
The most frequent risk for HCV is sharing needles/works to inject drugs (illicit as well as steroids, insulin, etc) At least 60% of the reported HCV cases are related to injecting drugs Sexual transmission does occur, but it is inefficient (20%) Inmates are 10x more likely to have HCV than the US population

Signs & Symptoms of Acute HCV
Most persons with HCV do not have symptoms Many persons with chronic HCV have mild to moderate liver damage but do not feel sick Some people with an acute infection will have jaundice (skin and/or eyes) or mild flu-like symptoms Most individuals with hepatitis C do not have symptoms. Liver disease progresses so slowly that a person can have hepatitis C for years without having symptoms. Many individuals with chronic hepatitis C have mild to moderate liver damage but do not feel sick. The possible symptoms for an acute infection (newly acquired) and a chronic (persistent) infection are different. ACUTE INFECTION (newly acquired) Often, people with an acute HCV infection are asymptomatic (have no symptoms). Some people with an acute HCV infection will have jaundice (a yellowing of the skin and eyes) or mild flu-like symptoms

Signs and Symptoms of Chronic HCV infection
Most people with chronic HCV will only have mild to moderate liver disease Symptoms may include: Jaundice - Fatigue Loss of appetite - Nausea CHRONIC INFECTION (persistent) Most people with chronic HCV will have only mild to moderate liver disease. Symptoms of this may include: Jaundice Fatigue Loss of appetite Nausea

Learning Objective 1.9 Learning Objective: The student will be able to describe the relationship between acute and chronic HCV infection.

Relationship between Acute & Chronic HCV
There is no treatment for acute hepatitis C Over time HCV may cause your liver to stop working and a new liver from a donor may be needed Antiviral medicines for chronic hepatitis C are available, but they are expensive and have significant side effects Most persons with acute infection experience few, if any, symptoms and are unaware they’re infected. Most people with HCV will not have symptoms for up to years after being infected. There is no treatment for acute hepatitis C. Out of 100 persons infected with HCV, approximately will spontaneously clear the virus without treatment. The other go on to develop chronic infection. There are approximately 4 million Americans who have been infected with HCV. 1.8% of the population is infected with HCV. Over time HCV may cause your liver to stop working and a new liver from a donor may be needed. Antiviral medicines for chronic hepatitis C are available.

Natural History of HCV Infection
100 People Resolve (15) 15% Chronic (85) 85% Cirrhosis (17) Stable (68) 80% 75% Stable (13) Mortality (4) 25% Time 20% Leading Indication for Liver Transplant

BloodBorne Pathogens for Law Enforcement (Length: 19 minutes)
This video is strictly for visual aid and is not required to teach this course. It is a good tool that can help gain a better understanding of the material. If your agency is a member of the Texas Municipal League Intergovernmental Risk Pool (TML), you can contact them at to acquire this video. If your agency is a member of the Texas Association of Counties (TAC), you can contact them at 5974.

Unit Two 2.0 Functional Area: This section will introduce the student to HIV/AIDS, HBV, and HCV. The student will be able to demonstrate on a written examination an understanding of the relevant terms and definitions of HIV/AIDS, HBV and HCV.

Learning Objectives Learning Objective 2.0: The participant will be able to Learning Objective 2.1 :The participant will be able to. Learning Objective 2.2 :The participant will be able to. Learning Objective 2.3 :The participant will be able to.

Learning Objective 2.1 Learning Objective: The student will be able to list the four methods of transmission of HIV, HBV and HCV.

HIV, HBV & HCV Transmission
HIV, HBV, and HCV have similar transmission routes and are spread by direct contact with body fluids: Body Fluids (confirmed risk) Blood Semen Vaginal/cervical secretions Breast milk (HIV & HBV only) HIV, HBV, and HCV have similar transmission routes and are spread by direct contact with body fluids: Body Fluids (confirmed risk) Blood Semen Vaginal/cervical secretions Breast milk (HIV & HBV only)

Body Fluids (theoretical risk) Saliva Perspiration Tears Feces Urine Body Fluids (theoretical risk) - Saliva - Perspiration - Tears - Feces - Urine

HIV, HBV and HCV Transmission
Blood Sharing needles/syringes and/or equipment “works” to inject drugs (IDU) Blood transfusions/blood products (all blood products have been screened for HIV and viral hepatitis B and C since 1992 so the chance of becoming infected through a transfusion is extremely rare). Occupational exposures Tattooing/piercing in unlicensed facilities HIV, HBV, and HCV Transmission: Blood Sharing needles/syringes and/or equipment to inject drugs (IDU) Blood transfusions/blood products (because of blood-screening techniques developed and implemented the chance of becoming infected through transfusion is extremely small. Occupational exposures Tattooing/piercing

Sexual Transmission Unprotected vaginal, anal, oral sex regardless of partners’ gender Sexual transmission of HCV is low or inefficient, although any sexual activity that involves blood-to-blood contact (including menstrual blood) with an infected person can potentially transmit HCV “High-risk” sexual activity (e.g. multiple partners, presence of other sexually transmitted disease, exchange of sex for drugs and/or money, etc.) appears to increase the risk of HCV transmission HIV, HBV, and HCV Transmission: Sex Unprotected vaginal, anal, oral sex regardless of partners gender Sexual transmission of HCV is low or inefficient, although any sexual activity that involves blood-to-blood contact (including menstrual blood) with an infected person can potentially transmit HCV. “High-risk” sexual activity (e.g. multiple partners, presence of other sexually transmitted disease, exchange of sex for drugs and/or money, etc.) appears to increase the risk of HCV transmission.

Birth From an HIV, HBV or HCV infected mother to her baby during pregnancy, birth, or breast-feeding (HIV & HBV only) A woman who tests positive for HIV during pregnancy can take medication to reduce the risk of transmission to the baby from approximately 20% without medication to as low as 2-8% with medication Breast-feeding is considered safe for HCV, but cracked and/or bleeding nipples could increase the risk of HCV transmission Transmission from an HCV infected mother to her baby occurs in less than 5% of births. At the same time, rates of infection can be as high as 20% if the mother is also HIV positive HIV, HBV, and HCV Transmission: Birth From an HIV, HBV or HCV infected mother to her baby during pregnancy, birth, or possible breast-feeding (HIV & HBV only). Breast-feeding is considered safe for HCV, but cracked and/or bleeding nipples could increase the risk of HCV transmission. Transmission from HCV infected mother to baby occurs in less than 5% of births. Rates of infection can be as high as 20% if the mother is also HIV positive.

Misconceptions There is no risk of exposure from donating blood
There is no evidence of transmission from human bites, insect bites, scratches, or spit (saliva) There is no evidence of transmission from casual contact; i.e. closed-mouth or “social kissing” There is no evidence of transmission from sharing food, drink, or handling food trays There is no evidence of transmission from sharing laundry facilities There is no evidence of transmission from toilet seats and/or insects 2.2 Learning Objectives: The student will be able to identify common activities which will not result in exposure to the HIV or HBV. There is no risk of exposure from donating blood. There is no evidence of transmission from human bites, insect bites, scratches, or spit (saliva). There is no evidence of transmission from casual contact; i.e. closed-mouth or “social kissing”. There is no evidence of transmission from sharing food, drink, or handling food trays. There is no evidence of transmission from sharing laundry facilities. There is no evidence of transmission from toilet seats and/or insects

Learning Objective 2.3 Learning Objective: The student will be able to identify relationship between HIV and HBV/HCV. 2.3 Learning Objectives: The student will be able to identify relationship between HIV and HBV/HCV. The potential for transmission of HBV is greater than HIV. HBV is easier to catch than HIV because it is more than 100 times more concentrated in an infected person's blood. HBV can live outside the body longer than HIV. Vaccines are available for prevention of HBV. Relationship between HBV and HIV HBV and HIV share the same transmission routes; persons at risk for HIV infection are also at risk for HBV infection. HIV infection can impair the response to hepatitis B vaccination. Acute HBV infection in HIV-infected persons is more likely to lead to chronic HBV infection.

Relationship between HIV & HBV
Potential for transmission of HBV is greater than HIV HBV is easier to catch than HIV because it is more than 100 times more concentrated in an infected person's blood HBV can live outside the body longer than HIV Vaccines are available for prevention of HBV

Relationship between HIV & HBV
HBV and HIV share the same transmission routes; persons at risk for HIV infection are also at risk for HBV infection HIV infection can impair the response to hepatitis B vaccination Acute HBV infection in HIV-infected persons is more likely to lead to chronic HBV infection

Unit Three 3.0 Functional Area: This section will introduce the student to personal and occupational practices that place individuals at risk of exposure to HIV, HBV, and HCV.

Learning Objectives Learning Objective 3.0: The participant will be able to Learning Objective 3.1 :The participant will be able to. Learning Objective 3.2 :The participant will be able to. Learning Objective 3.3 :The participant will be able to. Learning Objective 3.4 :The participant will be able to. Learning Objective 3.5 :The participant will be able to.

Learning Objective 3.1 Learning Objective: The student will be able to identify personal behavior that places individuals at risk of exposure to HIV, HBV, and HCV.

Assessing HIV, HBV, and HCV Risk
Factors in the “Formula” for assessing HIV, HBV, and HCV risk Which body fluid (blood, semen etc…) Route of entry into body (blood stream, mucous membranes) Dose of infected fluid How long fluid is out of body before another person has contact with it Number of exposures Condition of host (how high is their viral load) Condition of recipient (immune system, other STDs) Factors in the “Formula” for assessing HIV, HBV, and HCV risk Which body fluid (blood, semen etc…) Route of entry into body (blood stream, mucous membranes) Dose of infected fluid How long fluid is out of body Number of exposures Condition of host (how high is their viral load) Condition of recipient (immune system, other STDs)

Assessing HIV, HBV and HCV Risk
In descending order; the HIV risks for anal, vaginal, and oral sex: Receptive anal intercourse with ejaculation and no condom Receptive vaginal intercourse with ejaculation and no condom Insertive anal intercourse and no condom Insertive vaginal intercourse and no condom Receptive anal or vaginal intercourse with a condom* Insertive anal or vaginal intercourse with a condom* In descending order; the HIV risks for anal, vaginal, and oral sex[1]: Receptive anal intercourse with ejaculation and no condom Receptive vaginal intercourse with ejaculation and no condom Insertive anal intercourse and no condom Insertive vaginal intercourse and no condom Receptive anal or vaginal intercourse with a condom* Insertive anal or vaginal intercourse with a condom* Receptive oral sex with a man with ejaculation Oral sex with a woman Receptive oral sex with a man with pre-cum Receptive oral sex with a man with no ejaculation or pre-cum Receptive oral sex with a man with a condom* Receptive oral sex with a woman with a latex barrier over the vulva *Risk is lower if there is no ejaculation But remember, any one of the activities is safe if the persons engaged in the activity are not infected with HIV, HBV and/or HCV. One person has to be infected to be able to transmit the infection; the activity alone does not put someone at risk. [1] Risk Reduction: Sex Without Condoms. HIV Counselor Perspectives. 2001; 10(2):1-8

Assessing HIV, HBV and HCV Risk
Receptive oral sex with a man with ejaculation Oral sex with a woman Receptive oral sex with a man with pre-cum Receptive oral sex with a man with no ejaculation or seminal fluids Receptive oral sex with a man with a condom* Receptive oral sex with a woman with a latex barrier over the vulvae *Risk is lower if there is no ejaculation In descending order; the HIV risks for anal, vaginal, and oral sex[1]: Receptive anal intercourse with ejaculation and no condom Receptive vaginal intercourse with ejaculation and no condom Insertive anal intercourse and no condom Insertive vaginal intercourse and no condom Receptive anal or vaginal intercourse with a condom* Insertive anal or vaginal intercourse with a condom* Receptive oral sex with a man with ejaculation Oral sex with a woman Receptive oral sex with a man with pre-cum Receptive oral sex with a man with no ejaculation or pre-cum Receptive oral sex with a man with a condom* Receptive oral sex with a woman with a latex barrier over the vulva *Risk is lower if there is no ejaculation But remember, any one of the activities is safe if the persons engaged in the activity are not infected with HIV, HBV and/or HCV. One person has to be infected to be able to transmit the infection; the activity alone does not put someone at risk. [1] Risk Reduction: Sex Without Condoms. HIV Counselor Perspectives. 2001; 10(2):1-8

High Risk Individuals High-risk individuals are those who engage in behaviors that increase the chance of exposure to HIV, HBV, and HCV Male to male sexual intercourse People who share needles and/or “works” People who have sex for money or drugs People who have multiple sex partners People who have sexual intercourse with any of the above High-risk individuals are those who participate in behaviors that increase the chance of exposure to HIV, HBV, and HCV. Male to male sexual intercourse People who share needles, syringes, or sharps People who have sex fore money or drugs People who have multiple sex partners People who have sexual intercourse with any of the above

Substance Use The use of substances which impair judgment can result in the high-risk behaviors listed above. These substance include: intravenous drugs alcohol cocaine marijuana other substances that limit the brain’s ability to function normally The use of substances which impair judgment can result in the high-risk behaviors listed above. These substance include: intravenous drugs Alcohol Cocaine Marijuana other substances with diminish the brain’s ability to function normally

Learning Objective 3.2 Learning Objective: The student will be able to define occupational exposure, identify occupational risks to law enforcement and corrections personnel and the precautions that will reduce the chance of exposure.

Can Law Enforcement & Correctional Officers be Infected on the Job?
Every agency should have an Occupational Exposure Program (strategies & policies) There have been no reported cases of occupational exposure in the law enforcement or corrections Peace Officers and/or corrections personnel who have tested positive for HIV were infected through activities outside of the work environment Risk increases when blood/body fluids containing blood enter an open wound

Occupational Exposure
The exposure occurs during the performance of the employee’s duties; There is a route of exposure—in other words, a way for the viruses to enter your body. This could happen in one or more of the following ways: A percutaneous injury (i.e., needle stick, puncture wound or cut with a contaminated object, or from a human bite that breaks the skin); or Contact with the mucous membrane linings of the eyes, nose and/or mouth; or Contact with the skin, especially if the exposed skin is chapped, abraded or afflicted with dermatitis, or the contact is prolonged or involving an extensive portion of the body.

Occupational Exposure
If the employee is exposed to a body fluid to which universal precautions apply. These fluids include: Blood (including menstrual) Semen Vaginal secretions Amniotic fluid Cerebrospinal (brain and backbone) fluid Synovial (joint) fluid Pleural (chest) fluid Peritoneal (abdominal) fluid Pericardial (heart) fluid Saliva (in a dental setting is considered a risk factor for HIV exposure since it is possible that blood or tissue may be present in the saliva In a law enforcement setting or correctional setting, the only fluids you should be concerned about coming into contact with are blood, semen, and possibly vaginal secretions. All the other fluids listed above are body cavity fluids and unless you are working in an operating room, you should never be exposed to them. (If you are a correctional officer and get spinal fluids on your hands, you’re probably operating outside of your job description.) The body fluids that law enforcement and peace officers are most likely to come into contact with don’t transmit HIV or hepatitis unless visible blood is present. These fluids include: Feces Nasal secretions Saliva* Sputum Sweat Tears Urine Vomit *Saliva in a human bite is considered a risk factor for the transmission of hepatitis B only, although the CDC has never documented a case of a person contracting HBV this way. When we talk about the risks of occupational exposure we always use the example of getting stuck with a known HIV-positive patient’s contaminated (bloody) needle. Not just anybody’s needle—an HIV-positive patient’s needle. And not just any kind of needle—a used hypodermic (hollow-bored) syringe. (In corrections, tattoo needles found under bunks and behind dayroom benches are usually made from pieces of wire or staples filed to a point and therefore are far less of a risk than hypodermics.)

What about Biting or other Fluids?
Biting is not a common way to transmit HIV, HBV and/or HCV There have been numerous reports of bites that did NOT result in HIV infection Saliva, tears and/or sweat has never been shown to result in the transmission of HIV Exposure to saliva, urine and/or feces (or when fluids have been purposely contaminated with blood) have not resulted in any documented cases of HIV transmission Biting In 1997, CDC published findings from a state health department investigation of an incident that suggested blood-to-blood transmission of HIV by a human bite. There have been other reports in the medical literature in which HIV appeared to have been transmitted by a bite. Severe trauma with extensive tissue tearing and damage and presence of blood were reported in each of these instances. Biting is not a common way of transmitting HIV. In fact, there are numerous reports of bites that did not result in HIV infection. Saliva, Tears, and Sweat HIV has been found in saliva and tears in very low quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

Learning Objective 3.3 Learning Objective: The student will be able to list specific criminal justice job related behaviors that may put them at risk for occupational exposure.

Occupational Risks Occupational exposure is greatest in health care workers who experience a hollow-borne needle stick from an HIV, HBV, or HCV infected person Law enforcement & corrections personnel may be at risk if they fail to utilize precautions: Encountering blood or potentially infectious body fluids, cleaning up body fluid spills Conducting body and cell searches, or handling evidence that results in a puncture of the skin Intervening in fights Occupational exposure is greatest among health care workers who experience a needle stick from an HIV, HBV, or HCV infected person. Law enforcement and corrections personnel may be at risk if they fail to utilize precautions when: Encountering blood or potentially infectious body fluids, cleaning up body fluid spills Conducting body searches, cell searches, or handling evidence that results in punctures of the skin Intervening in fights As a law enforcement or correctional officer, you are not at risk if potentially infectious body fluids are thrown at you and do not penetrate the skin. You must, however, use common sense and good personal hygiene since other disease causing organisms may be present.

Learning Objective 3.4 Learning Objective: The student will be able to list universal precautions for occupational exposure to HIV, HBV, and HCV.

Universal Precautions & Preventive Measures
Gloves Cover cuts, sores or breaks in the skin Wash hands or other areas exposed to blood Clean all spills with 1:10 bleach: water mixture Avoid sharing objects that could have blood on them (razors, toothbrushes) Dispose of needles/sharp instruments Gloves should be worn during contact with blood or other body fluids that could possibly contain visible blood, such as urine, feces, or vomit. Gloves are recommended when conducting cell, clothing and body cavity searches, as well as in other situations where exposure to blood is likely to take place. Officers should select the type of glove that provides the best balance of protection and search efficiency. Cuts, sores, or breaks on both the care giver’s and patient’s exposed skin should be covered with bandages. Hands and other parts of the body should be washed immediately after contact with blood or other body fluids, and surfaces soiled with blood should be disinfected appropriately. Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes, should be avoided. Needles and other sharp instruments should be used only when medically necessary and handled according to recommendations for health-care settings. (Do not put caps back on needles by hand or remove needles from syringes. Dispose of needles in puncture-proof containers out of the reach of children and visitors.)

Learning Objective 3.5 Learning Objective: The student will be able to list the prevalence of reported HIV, HBV, and HCV cases.

Reported Cases To date there have been no reported cases of HIV in correctional or law enforcement personnel as a result of occupational exposure Published reports do not document any increased risk for HBV infection among public safety workers To date no reported HIV infections as a result of CPR, with or without a one way pocket mask To date no reported HIV infections as the result of contaminated surfaces or environment

Keeping Your Guard Up (Length: 23 minutes)
Learn what you need to know to stay safe Exposure Risks for HIV and Hepatitis for Peace Officers, Detention and Correction Officers Contact the CDC National Prevention Information Network at

Unit Four 4.0 Functional Area: In this unit of instruction the student will be able to list the infection control procedures and steps used to conduct searches and handling evidence during the performance of the job.

Learning Objective 4.1 Learning Objective: Students will be able to list the eight general infection control procedures as outlined by the Texas Commission on Law Enforce- ment, “Facts on AIDS: A Law Enforcement Guide”.

Infection Control Procedures
Use disinfectants such as: - 70% isopropyl alcohol - one part bleach to ten parts water - waterless soap Wash hands after contact with bodily fluids with hot, soapy water Clean and bandage all cuts and abrasions Body fluid spills should be wiped up immediately and the surface area should then be disinfected

Soiled clothing may be cleaned in hot, soapy water or dry cleaned Instruments, padding, helmets, weapons, floors, vehicles and other soiled items can be cleaned with soap and water, while wearing disposable latex gloves. Sterilize with disinfectants like diluted bleach and water (1:10 ratio) or rubbing alcohol Dispose of used needles in puncture-proof containers. Do not break or try to re-cap a needle, as you may jab yourself.

Prepare a first aid kit for your vehicle containing the following items: - 70% isopropyl alcohol - sterile wipes - sterile gauze - tape - plastic sharps container - latex gloves - Ziploc plastic bags

Learning Objective 4.2 Learning Objective: Students will be able to describe five of seven precautions that should be taken that with involved searches or evidence handling as outlined in the National Institute of Justice “AIDS Bulletin,”

Searches & Evidence Handling Precaution
Use puncture proof containers to store sharp instruments and clearly marked plastic bags to store other possibly contaminated items Whenever possible ask suspects to empty their own pockets Whenever possible, use long-handled mirrors to search hidden areas If it is necessary to search manually, always wear protective gloves and feel very slowly and carefully

Searches & Evidence Handling Precaution
Use tape – never metal staples – when packaging evidence Wash hands thoroughly with soap and running water when tasks are completed Use good personal hygiene and common sense

Unit Five 5.0 Learning Objective: The student will be able to list and briefly describe the State and Local laws that govern the communicable diseases identified in this curriculum.

Learning Objective 5.1 Learning Objective: The student will be able to describe provisions of the federal law American Disability Act of 1990 and the Federal Rehabili- tation Act of 1973.

Federal Laws & Legal Issues
American Disability Act 1990: In June of 1998, the high court stated that people infected with HIV/AIDS were entitled to protection under Americans with Disabilities Act, regardless if they were asymptomatic Employers must make reasonable accommodations for the infected person When criminal justice professionals learn about an individual’s HIV status through self-disclosure or other means, they must realize that if an individual exhibits no behavior for isolation, that the detention, booking and processing policies within their agency dictates how these individuals must be handled; HIV is no exception Some criminal justice professionals practice selective enforcement because of someone’s known HIV status, which is discriminatory Some peace officers also refuses to provide lifesaving first aid based on their opinion that the individual belongs to a high-risk group Hepatitis is covered under ADA

Federal Rehabilitation Act of 1973: Section 504 PROTECTS QUALIFIED PERSONS WITH HIV INFECTION applies to employers and organizations which receive federal financial assistance from any Federal department or agency, including the DHHS. The DHHS Section 504 regulation can be found at 45 CFR Part 84. If a person with HIV infection have been terminated from their jobs, denied access to social services, or denied medical treatment solely because of their handicap. Individuals have been similarly treated because they have been perceived as having HIV infection. Such actions by an agency, institution, hospital, nursing home, drug treatment center, clinic, organization or other entity receiving Federal funds may constitute unlawful discrimination under Section 504. Hepatitis is not covered by the Federal Rehabilitation Act of 1973

OSHA 29CFR : The employer shall make available the at no cost to the employee hepatitis B vaccine and vaccination series to all employees at risk, who have been exposed, and post exposure evaluation and follow-up to all employees who have had an exposure incident Hepatitis B vaccination shall be made available after the employee has received training required in para (g)(92)(vii)(I) and within 10 working days of initial assignment of all employees who have occupational exposure unless the employee has received the complete hepatitis B vaccination series and antibody testing has revealed that the employee is immune or the vaccine is contraindicated for medical reasons Hepatitis is not covered by the Federal Rehabilitation Act of 1973

OSHA 29CFR : The employer shall not make participation in a prescreening program a prerequisite for receiving hepatitis B vaccination If an employee initially declines hepatitis B vaccination but at a later date while still covered under the standards decides to accept vaccination, the employer shall make available hepatitis B vaccination at that time The employer shall assure that employees who decline to accept hepatitis B vaccination offered by the employer sign the statement in Appendix A of 29CFR Hepatitis is not covered by the Federal Rehabilitation Act of 1973

OSHA 29CFR : Each employer having an employee(s) with occupational exposure as defined by paragraph (b) of this law shall establish a written Exposure Control Plan designed to eliminate or minimize employee exposure Employers shall ensure that a copy of the Exposure Control Plan is accessible to employees in accordance with 29CFR Exposure plan shall be reviewed and updated at least annually and when ever necessary to reflect new or modified tasks and procedures procedures. Hepatitis is not covered by the Federal Rehabilitation Act of 1973

OSHA 29CFR : When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protection equipment such as gloves, gown, lab coats, face shields (masks) and eye protection, mouth pieces, resuscitation bags, etc Hepatitis is not covered by the Federal Rehabilitation Act of 1973

Learning Objective 5.2 Learning Objective: The student will be able to list and briefly describe the state laws that govern the communicable diseases identified in this curriculum.

State Laws & Legal Issues
Texas Health and Safety Code, Chapter 81- Subchapter A Prevention, Control and Reports of Diseases Code of Criminal Procedure, Chapter 46A AIDS and HIV Testing in County and Municipal Jails Government Code, Chapter 507- Subchapter A Inmate Welfare State Jail Felony Facilities Government Code, Chapter 607 Benefits Relating to Certain Contagious Diseases

HIV Testing in Texas’ Prisons
Across The Nation | Texas Attorney General Gregg Abbott Rules that State Law permits prison officials to mandate HIV Testing among State Prisoners The state prison system in August 2006 had proposed a change to its HIV testing policy from saying new inmates "should be tested" upon entering prison to saying they "shall be tested" unless they opt out of testing. Feb 05, 2007, Texas Attorney General Greg Abbott (R) ruled that state law permits the Texas Board of Criminal Justice to mandate HIV testing among inmates upon entry to state prisons, the Houston Chronicle reports (Babineck, Houston Chronicle, 2/2). Sponsored legislation approved last year that requires inmates to be tested for HIV before departing prison.

About 80% of inmates have agreed to take an HIV test upon entering prison since the state began its testing program, and prison system statistics show more than 38,700 inmates received HIV tests in Of those, 372 tested HIV-positive. Texas law mandates that HIV test results are confidential and that HIV-positive inmates are not separated from HIV-negative inmates. Advocates for mandatory HIV testing upon entry into the prison system say it would help prison officials properly treat HIV-positive people, would provide more accurate data on the spread of the disease and could help officials estimate how many people are becoming HIV-positive in prison.

July 2006 statistics show that of 154,000 prisoners in Texas, 2,627 are HIV-positive (Kaiser Daily HIV/AIDS Report, 8/24/06). Abbott's opinion, which leaves the decision regarding mandatory testing up to the Texas Department of Criminal Justice, says that TDCJ is "authorized to adopt a rule or policy requiring mandatory" HIV testing among "incoming offenders in both the institutional division and the state jail division." According to TDCJ spokesperson Jason Clark, there is no indication that the department is planning to make HIV testing among incoming prisoners mandatory anytime soon.

State of Texas Statistics
Statistical Information On HIV/AIDS Calendar Year Average Offender Population # Tests # Positive HIV Population AIDS Population 1996 132,386 25,721 549 1,377 499 1997 140,729 29,024 691 1,282 819 1998 142,924 49,114 971 1,452 941 1999 145,474 55,468 837 2,520 994 2000 149,021 57,194 714 2,492 922 2001 144,900 51,904 652 2,388 859 2002 144,097 56,626 703 2503 828 2003 147,850 64,885 656 2460 778 2004 149,120 67,677 618 2405 801 2005 151,647 70,064 615 2400 894

Additional Training Videos
Texas Associations of Counties (Members Only) Blood-borne Pathogens For Corrections Silent War 1- Infection Control For Law Enforcement: Understanding Contagious Diseases Silent War 2-Infection Control For Law Enforcement: Reducing Your Risk Silent War 3-Infection Control For Law Enforcement: Post-Incident Procedures Texas Municipal League (Members Only) Blood-Borne Pathogens Backup: Force Continuum

Final Comments or Questions?
What other questions or concerns do you have? End-of-course exam Please fill out the course evaluation Be safe and remember, most HIV and Hepatitis infections can be prevented Thank you for your time and attention The potential for exposure to HIV/AIDS in law enforcement or correction work compared to the exposure to Hepatitis remains a minimal. If peace officers and correction personnel follow the universal precautions, the risk decreases. Fear of the unknown can constitute an important factor because it can permeate an organization.

Questions?

DEFINE & PROCESS Define 7.0: Explain the key points – elements for Human Trafficking Investigation Process: 125

SOURCES ADVANCED HUMAN TRAFFICKING TCOLE Course # 3271 All Course Sources and/or Resources are listed in your Participant Handout

“POWER” Stay informed, stay SAFE, stay Vigilant & stay Alive”
“Knowledge is “POWER” Stay informed, stay SAFE, stay Vigilant & stay Alive”

Bexar County Constable’s Office PCT#4 TRAINING SCHEDULE 2014
UPCOMING TRAINING Bexar County Constable’s Office PCT#4 TRAINING SCHEDULE 2014 Current TRAINING Schedule of Courses offered by Bexar County Constable’s Office PCT#4 Racial Profiling Course – TCOLE Course #3256 (4-hrs) 4hrs on Saturday October 4th, 2014 from 10:30 am to 7:30 pm. Racial Profiling Course – TCOLE Course #3256 (4-hrs) on Friday October 10, 2014 from 8:00 am to 5:00 pm Eye Witness Evidence Course – TCOLE Course # 3286 (4-hrs) Saturday October 11, 2014 from 10:30 am to 2:30 pm Eye Witness Evidence Course – TCOLE Course # 3286 (4-hrs) Sunday October 12th, 2014 from 11:00 am to 3:00 pm. Eye Witness Evidence Course – TCOLE Course # 3286 (4-hrs) Friday October 17th, 2014 from 1:00 pm to 5:00 pm.

Advanced TCOLE Instructor Course – TCOLE #1017 (40hrs), Day One Saturday November 1st ,2014 from 11:00 am to 6:00 pm (Deputy Chief George D. Little and Deputy Constable Roland Berg) Advanced TCOLE Instructor Course – TCOLE #1017, Day Two Sunday November 2nd ,2014 from 11:00 am to 6:00 pm (Deputy Chief George D. Little and Deputy Constable Roland Berg) Advanced TCOLE Instructor Course – TCOLE #1017, Day Three Friday November 7th ,2014 from 9:00 am to 6:00 pm (Deputy Chief George D. Little and Deputy Constable Roland Berg ) Lesson Presentation preparation time. Instructors available Advanced TCOLE Instructor Course – TCOLE #1017, Day Four Saturday November 8th,2014 from 11:00 am to 6:00 pm (Deputy Chief George D. Little and Deputy Constable Roland Berg)

Advanced TCOLE Instructor Course – TCOLE #1017, Day Five & Grad Sunday November 9th, 2014 from 11:00 am to 6:00 pm – Presentations, Final Test & Graduation (Deputy Chief G. D. Little and Dep. Constable R. Berg ) HIV-AIDS & Viral Hepatitis in Criminal Justice Profession Course – TCOLE # 3804 (8-hrs) 8-hrs on Saturday November 15th, 2014 from 10:00 am to 6:00 pm. HIV-AIDS & Viral Hepatitis in Criminal Justice Profession Course – TCOLE # 3804 (8-hrs) 4-hrs on Thursday December 4th, 2014 from 1:00 am to 5:00 pm HIV-AIDS & Viral Hepatitis in Criminal Justice Profession Course – TCOLE # 3804 (8-hrs) 4-hrs on Friday December5th, 2014 from 1:00 am to 5:00 pm KNOWLEDGE IS POWER

TAKE A 15-MINUTE BREAK

COURSE & INSTRUCTOR EVALUATION Form
Please complete a course and instructor evaluation form. If you rate 2 or below you must justify on reverse side. Constructive Criticism helps all, being negative helps no one.

Exam Graduation THANK YOU & STAY SAFE

HIV/AIDS & Viral Hepatitis In the Criminal Justice Profession

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